Hillsdale Hospital News

Episode 74: How Regulations & Industry Trends Impact Rural Hospital Finances

Rural hospitals face significant financial strain to the point of closure for more than 140 hospitals since 2010. Additionally, we are seeing many others facing a high and/or immediate risk of closing in the near future. Today, we dive back into this very important topic with our guest, David Usher, Chief Financial Officer at Ray County Memorial Hospital.


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Rachel: Rural hospitals have been, and still are thought of by some as not always necessary and not always providing the highest quality care, even after the role rural hospitals played in the Kova 19 pandemic, serving as a lifeline to patients who desperately needed care. So how do rural hospitals make their case for the important role they play and promote funding models to support long.

JJ: Term financial stability, with constant attention to policy issues, collaboration with peer hospitals, and a willingness to advocate?

Rachel: I’m Rachel Lott.

JJ: And I’m JJ Hodshire.

Rachel: And this is Rural Health rising.

JJ: Welcome to episode 74 of Rural Health Rising. I’m JJ Hodshire, president and chief executive officer of Hillsdale Hospital.

Rachel: And I’m Rachel Ladd, director of Marketing and Development.

JJ: So, Rachel, we know that rural hospitals face significant financial strain to the point of closure for more than 140 hospitals since 2010. And we had various speakers in the last few months, including Scott Becker, talking about the closure of many, many others in the very near future. Risk and immediate risk, hundreds and hundreds of hospitals. So today we’re going to dive back into this very important topic, which in large part was what inspired Rural Health Rising.

Rachel: That’s right. And we are talking to someone who lives and breathes this every day and is very passionate about articulating these issues.

JJ: It’s right. Our guest today is David Usher, chief financial officer at Ray County Memorial Hospital in Richmond, Missouri. Welcome to Rural Health rising David.

David Usher: Thank you I’m really excited to be with you.

Rachel: So, to start, David, why don’t you tell us a little bit about yourself, your background and your work at Ray County Memorial Hospital?

David Usher: Okay. Because you haven’t figured it out. I’m really not from around here. I was born in the UK on English. I moved to the US about 23 years ago, give or take. I actually cut my teeth in the UK brewing and frank’s industry, which obviously did not get. I came to the US. My wife was born in the US. We moved here.  I worked for an industrial boiler manufacturer in Milwaukee for a few years and stumbled into health care. I was on vacation in Colorado, went to see my in laws and kind of like the area they were in on the western slope of the Rockies. Pretty area. Local hospital was looking for at that time, I think a staff account or something. I thought, H***, that sounds like a great job. Yeah. Rachel: In a beautiful place. I fell in love with rural America and got into rural health care. And I’ve been working in New Mexico, Wisconsin a couple of times. Kansas, Colorado applies. So, I moved around a little bit, and I’m now in Missouri another three years in a physician owned facility in New Mexico. It was a for profit facility, which was a really interesting experience. I got to say.  I’ve been pretty exclusive to rural critical access hospitals. Ray county memorial hospital is a critical access hospital. It’s located in northwest Missouri, about 30 miles northeast of Kansas City, and there about three other critical access hospitals within 25 miles. Loads of health care in Kansas City, obviously 25,000 population within our castle area, which is absolutely fascinating for a small hospital. Way out of line with anything else I’ve seen.  We have 200 employees. We provide all the usual services. So recently updated campus is really a good place to be. It presents some very different challenges, frankly, from what I used to see in small town rural hospitals. JJ: You know, David, now that we’ve kind of established your background and what you do as a chief financial officer, let’s start with the why now.

JJ: We do this on every episode so we get to know our guests just a little bit better. And I want to know what is your why? What motivates you? What gets you up out of bed in the morning to do the job that you do? Because I want to tell you, being a CFO in today’s times and then to be a CFO at a hospital and then a CFO at a rural hospital, that has been described as probably one of the most challenging jobs in the industry right now. So, what is your why?

David Usher: Well, I was bought out and trained as an accountant. Accountants generally don’t get a chance to do good things buried in figures. We’re worried about profit. We’re worried about return on investment to actually get to impact things. The last two years have been exceptionally good example of how much impact somebody in my position can make. I can help keep the doors open for these community hospitals. I actually get to make a contribution to the community. I feel like it’s tangible. I can feel it. I can touch it. Every day I’m when actually contributing, even if I’m not laying hands on a patient or seeing the patient. Sometimes, I guess I fell into rural health care by accident, and I stayed here by choice: It’s a beautiful opportunity to help our communities.

JJ: And Rachel and I, at times we just say it’s God’s work because this is kind of a mission field here, and the work that we do isn’t famous, it’s not popular, but it’s so necessary in our respective and I don’t know what your payer mixes, but we are a very poor community here in Hillsdale County, and that’s typically what we find in rural America. So, it’s truly a mission field for many of us. And it sounds like it is for you as well. So, David, let’s talk about the serious problem that we have that needs urgent exposure and attention. So, in your experience, how are rural hospitals being seen by decision makers? And what makes that a little dangerous?

David Usher: Well, I think they just see us as one. Maybe the hospital is a hospital, healthcare is healthcare. I think they struggle to differentiate between a rural hospital and an urban hospital, which we have a for profit, not for profit, even between county hospital and a tax district hospital. The differences are tangible. They really are. I don’t think they really comprehend rural. It’s easy to point to politicians. I spend a lot of time with politicians and I find them extremely frustrating people to work with generally. Very true media reporting. It’s more important what the media reports and the truth. I work as closely as I am able to with health leaders and with modern health care, with other people in our business. But when you get outside of that, they’re looking for sensationalism. They’re looking for a sexy story that hospitals ripped off some who can’t afford it. That really is of great concern to me because I’m sure there are hospitals out there that are doing that. We’re not doing that. We’re trying very hard not to do that right now. I don’t need to make a lot of money out of everything I do just enough money to keep those up. I see a lot of stuff that talks about critical access hospital and how bad the cost base reimbursement is and how expensive it is. Those of us in the business know very well that’s not true. Convincing politician or a journalist that that’s not the case is proving very difficult: Very much. It takes people way more elegant than me to make an impact in those situations. I had a discussion with the guy who’s actually a city US senator, and we won’t mention any names. He’s actually adopted. He just could not conceptually understand what I was telling him about.

JJ: Yeah, we often have that same response, David, when we’re speaking with our congressional friends, because it’s such a fascinating and diverse industry. It’s not like, as they can see, they just have an opportunity to go in and tory factory that’s making certain parts that has a supply and a demand. And if there is a higher supply, they can raise the price, and if they have a higher price per unit, they can raise the price. And I was having that same discussion a few months ago, just about the complexities of when the supply chain shifts for us and we get charged more. David, are we able to charge our patients more? No, we can’t shift the cost. And so those are the challenges I think you and I face in our roles. It’s hard to explain that because in the free market economy, it’s simple. All right. The candy bar, which was a dollar and now dollar 25 because it costs more. Well, we can’t charge ten more, $1,000 for a surgery and get that reimbursement back from the federal and state government. And so, to your point, it is very frustrating at times to have those discussions because of the complexity of health care. But it sounds like in specific to your region, you’re having those conversations. You’re a critical axis hospital that I would say doing remarkably well in consideration of what’s happening around us. So, hats off to you and your team at providing that much needed service in your community. Because one thing that we have to remember is it’s about access for our patients. And to your point, David, congratulations. Staying open during Covet and finding a mission and a passion to take care of our patients, wasn’t that what it was all about? Throw the political rhetoric away, throw the conversation way, but it’s providing that location and those amazing, great services. So, congratulations to you and your hospital for that work.

Rachel: Well, and let’s talk a little bit too about that perception that we’ve seen for a long time of rural hospitals are really not necessarily seen as an absolute necessity for a community. It’s seen like as if it’s a nice to have right. But during Covet, I would hope that I know we saw more attention on rural hospitals because the need was so much greater for beds, and especially in urban communities, shipping out patients to rural hospitals and the outskirts of their areas or even farther out because they literally had nowhere else to send them. Rural hospitals kind of stood in the gap during Covid 19 for our own communities, but also in certain circumstances, for larger health systems and for urban individuals. So how do you think that work during the pandemic that rural hospitals have done? How do you think that’s changed the perception of our policymakers? If it has, are we making any progress?

David Usher: I think it’s changed the perception of someone. It’s on you guys doing the stuff. You know, me doing whatever small part I complain it to make sure they understand that I think we have made a huge difference in the last couple of years. There’s no question. We have saved lives where people were in danger of not making it. We’ve had people on ventilators in this hospital and in my other hospitals. That’s not something that critical access hospitals are ever really built to do. We’ve done it and we’ve proved that we’re actually an integral part of the health system, right. And that we need to exist. You’re right. All we can do is sell our stories. Royal Health Rising is one of those things that’s doing it. There are others out there. National Rural Health Association has done a great job for us. We have to keep pushing that envelope. We get a message across well enough. I think the one problem with COVID is the politicization of COVID.

JJ: Correct.

David Usher: Made it a very difficult as a health system, small rural health system, we have done a great job in saving lives and doing what we get paid.

JJ: Absolutely. And so all around us, and I’m sure you get tremendous number of resources and information from Beckers and others, and you can’t open one of those emails or read an article and not see the downgrades of bonds, the Fitch giving basically their review of deteriorating hospital systems. And for you and I at the leadership level, this is some life changing information because not only are we providing health care services, but we’re most likely in our respective communities, some of the largest employers, I’m sure you are as well. And the thought of closure, the thought of a merger where the services are reduced is quite alarming. But I guess I want to ask you, as a CFO for a critical access hospital, what keeps you up at night when it comes to the funding aspect of it? We had the Cares Act, the ARPA funding, and those helped. Some are arguing that it created an artificial cash flow and created a ceiling that unfortunately a year later, some are arguing it kept places open longer than it should have. And so, there’s all kinds of arguments and thoughts out there and we know that it helped us. PPP was a lifesaver for us, and certainly looking at some of the payments that the government gave us in advanced payments, but the Cares Act, ARPA, all of these PPP, they’re not long term. So as a CFO, David, what keeps you up at night exactly.

David Usher: This year we still got Cobbing money; we’ve still got the ability to use that. There’s no question it kept doors open in hospitals that would not have made it through this time, no question. This one would have done. Others I’ve been with a stroll to stay, there no question. But I’m working budget. This is a facility has a 1031 fiscal year end, which I have no idea why. So, I’m working next year’s budget now. Where’s the money coming from to make up my lost revenues? Because the revenues have not come back correct in a meaningful way. It’s getting better. We’re working at it really hard to try and find better ways to do stuff, but it’s not back. So where does that come from? If you had the impact of inflation over the last twelve months or so, we are taking a hammer on so many fronts and there’s no believe we can get by. We just have to find a way. But it’s going to be difficult because we don’t have that to lean on.

JJ: David, could I ask you, what does recruitment look like for you? Is that a challenge for your critical access hospital or physicians or services?

David Usher: That’s a massive challenge, particularly from the nursing perspective. We have so much competition, so many hospitals are compared to pay a lot of money for laboring in Kansas City particularly. It’s really hard to keep people. We like to think we’re a great place to work. We can sell that. But there’s a limited listing. I’m seeing some easing of agency costs and things like that. Not massively, but definitely using a little bit. We’ve been running on temporary labor in our lab for a long time. I’ve never seen that in another hospital. No. So it’s a stretch. And replacing housekeepers’ maintenance guys is a struggle. It’s a stretch. So, this is a place where we have awfully large number of employees. We’ve been here a lot of years, 20, 30, 40-year employees. So, it’s a great place to work. It’s an important employer in the community. We’re not the biggest in the community, but as you say, we’re close to it. Labor is a stretch for us, and the labor market is a disruptor to our business, no question.

JJ: And it’s not even comparing hospital to hospital. We’re competing here with distribution centers for major manufacturing companies in chain stores. We’re competing, believe it or not, with gas stations and with Walmart.

Rachel: For entry level position.

JJ: I mean, they’re showing hanging signs in their window at $20 an hour and one $500 bonus sign on. And it’s just a very difficult market. It sounds like it’s the same thing for you in Missouri.

David Usher: Yeah, it’s very similar.

JJ: Yeah.

Rachel: Well, I think to your point, competing with these larger hospitals and even with the travel agencies, and we really got on our soapbox about that several episodes ago, about how just totally unacceptable, the lack of action on that price gouging.

JJ: 220 an hour, Rachel. 225.

Rachel: Completely outrageous. And no one seems to have batted an eye at it from a regulatory or legislative perspective. So that’s another topic for another episode. But with those issues competing with the larger hospitals, we’re even seeing now that these larger hospitals and large systems are posting bond ratings and credit downgrades and all of these things happening, as well as these multi million, sometimes tens of millions, hundreds of millions of dollars in quarterly losses for some of these major hospital systems, it makes me think two different things. My first gut reaction is now you know what it feels like to live in a world where financial stability is not an easy thing to achieve. And then on the other hand, it makes me think, isn’t it nice to be able to have a loss of that many millions of dollars and not have to literally shut your doors? And in rural, we don’t have that kind of luxury to book losses like that quarter after quarter after quarter and still stay open and still provide care to our patients. And then when I think about that, I just think of the regulatory issues of how larger hospitals have a voice in the federal government and in their state governments as they advocate for their interests just as we attempt to advocate for ours. And I think what we’ve seen, and you kind of alluded to this earlier, is that some regulations may be designed to target bad practices of larger hospitals, and those regulations can end up creating problems for smaller hospitals. In addition, some regulations can be crafted to support larger hospitals and in turn hurt rural hospitals. So, can you give us some examples of some of the issues you’ve seen? That it appears that this was aimed at curtailing a practice or at somehow repairing an issue for larger hospitals that has in effect, been a detriment to those of us who are in small and rural healthcare?

David Usher: Yeah, for sure. No surprise. If I started talking about no surprises and price transparency. It’s not something small hospitals, it’s not a problem small hospital to create. We really do not have a sign of maybe helicopter rise and things like that that we initiate. But it’s not us that’s making this charge and everything else we do. Our prices are not surprised. We don’t tend to have the out of network issues and in network issues with a small hospital. So, there’s no surprises act and price transfer out. It’s just driven. How do I present that in any way, shape or form with a fair amount of expensive expertise to help me do it? I don’t have the resources to do that. So, I think I’m a smart enough guy that the requirements that they’re piling into this thing, really, to satisfy politicians for first and bad actors in our industry. It’s killing us. The rural emergency hospital schools are a solution created by politicians, again, and supported, sadly, by some of our other institutions. CMS will tell you that rural emergency hospitals, they don’t expect it to me more than 50 or 60 in the country, right? Yeah, it solves nothing. I haven’t been in a hospital where I think would work with that model, and I’ve been in small hospitals. The other thing that really hurts me here, when you come from south central rural Kansas, you do not see Medicare Advantage plans very often. If you see one in your accounting, it’s got maybe ten members. You can live with that. I’m now in an area where a good percentage of my Medicare business is Medicare Advantage. These people do not settle up on the cost report. I have to get my revised rates really quickly, otherwise they won’t pay me. And I’m already a year behind on those, because that’s how the system works. They’re forcing pre approval, pre authorization on us. They’re paying us less than they should pay us. They’re way smarter than we are. They have way more invested in stopping payment, not paying than I can possibly invest in making. Those three things alone keep me awake. I console some of them, but it takes money and race.

JJ: So, there’s some signature legislative pieces that I watch and I monitor very closely. And so, I’m going to go a little off of our outline here for me, 340 B for me it’s a low volume adjustment. For me, I’ve got several things that I look at that it’s just like wow, if that comes true or if that does not get extended, the impact to my hospital is devastating. What one legislative piece right now David is something you’re watching very closely and that you are either trying to champion or argue for. Against. Can you share that with us?

David Usher: Truthfully is one of the things always been something I was very driven by. The nature of what we do here doesn’t actually impact us very much. We don’t actually employ any of our own physicians. That’s just the way this hospital works. In some ways that’s great. Otherwise, that’s a real problem because I don’t have any control over the end result time. So, three-point B is something I spend a lot of time over the last couple of years pushing back on really any opportunity to talk to a politician about it and explain it banging my head against the brick wall there. I don’t have the kind of money that the drug companies can put up to push back on 340 P. It’s a very good point. It’s such an important program for all hospitals.

JJ: It is.

David Usher: This one doesn’t benefit from it will probably do some work in the next couple of months to benefit what we can, but not lucrative. I came from hospital with 3400,000 would be one of the real strong things. I’m always nervous that we’re going to start taking a look at cost space and I think advantage is a backdoor way of removing its cost space. Most of what I’m concerned about what’s going on is I feel like we need to have people better informed of the damage they do by inactivity. At the federal level, for the most part the state levels. There is an interesting state for Medicaid. It’s never really expanded Medicaid, but we don’t provide effects which takes a lot of extra work. We’ve never really seen any of the benefits of Medicare expansion.

JJ: There’s a million things there is and we could sit here for probably 2 hours and talk about each of them individually. And one of the things that we shared with you earlier is that we had Scott Becker from Becker’s Healthcare here and on our podcast a few times and during the life. Okay. I’ve been on his program that we shared but we talked about and this has just been recent. The hundreds of hospitals that are at risk of closing and I alluded to that early on in this podcast today. But there is a major concern. I do shoulder 600 plus staff members every day when I consider going to bed at night and saying my prayers of God. Give me the wisdom, the strength, the encouragement to be able to ensure because too much is given, much is required and I am certainly very cognizant of that. But there are forces beyond you and I and I guess I’m going to ask you one of the most loaded questions you’re probably going to get and that’s what do you see as the path forward for rural hospitals and in that path what should leaders be doing?

David Usher: What I might focus is where I like to play because you can’t see it. Over here is a huge whiteboard and over here is another huge whiteboard. I write things down a lot on whiteboard. They love my whiteboards. One of the things on my whiteboard is a list of disruptors that are really bothering me and essentially there are people who figure out how to do our business better, cheaper and make money out. Yeah, my simple line says if they can do it, we both know there’s a set of regulations out there right. See I’m asking a whole bunch of other people that actually tell us we can’t do some of the things that they’re going to do but I think we have to figure out how we’re going to work with those people, emulate those people or get it to work in our favor. I mean it’s an easy list from Amazon, good old days Amazon which is a concern from an electronic point of view. They go out and buy one medical. Now they have bridge. Wolf Every night I see adverts on TV for Kansas City area from Alton who are doing medical clinics and doing home visits. They’re not in my area yet but they’re gone urging care. We’ve seen that blossom in rural areas much less than it has in urban areas. But it’s coming. I’ve got a semi urban area here. I’ve got a lot of people working Casey who travel out here to live in a nice rural area. Apparently, they don’t mind traveling half an hour and crazy traffic every day. I’m sure I understand that. We’ve got to start to look at those things and see what we can do. I was reading the other day about infusion centers. We already know that the metering people are now talking about having taken infusions into a central location. I look at it and wonder why we can’t do that. Hospital we have shoes campus. We have new real estate. We have enough money to invest in the future once we invest in price. I think those are things we just have to do. I think we have to work hard on our leads. We’ve got people on our side. We’ve got to keep working because for every good politician out there right we have to do that and we have to embrace technology. That’s all. Part of my big driver coming here is what can we automate and move particularly business office stuff but it goes across the business. Take people away from computers, away from machines and put them in front of the patients. I can have far more impact on the patient one on one than any other way unfortunately, we’ve got a trend in healthcare. The same people would much rather talk to you by text, much rather engaging apps. And we’ve got to take that into account too. That’s what we need to do. I think our industry is in danger of not being modern enough, I guess. Simplification we got to oneize what we do. We cannot sell our hands and say we always do fine. One of the charts. I have to present the board meetings, but it’s not my chart. I came here four months ago. It’s always been there, in charge of the profitability of the business over ten years. And it starts off all green on the right-hand side ten years ago. And it drifted across through black to red.

JJ: Yeah, to the red. When I started my tenure here, well over two years now as CEO. But prior to that, I spent a decade in as chief operating officer. But within the first week, I assembled our leadership team and I said, we’re going to have two words that you’re going to be able to speak and this is what’s going to drive the organization. It’s called a growth strategy. And I’m a firm believer in a biblical principle where there is no vision that people perish. And I think what we do, David, you and I set and we cast a vision for where we need to be and how. I look at my role when someone asks me tell me I don’t start going into servant leader, which I view myself as. But what I say is I want to be a disruptor. See, everybody asks me, who are the disruptors in your world? And I say there are a lot, but I want to be a disrupter because I think right now, we have got to fight like no one’s business to keep rural health. We know what happens. I know what happens. And you may have a different view than I do, but I do not believe in mergers and acquisitions as the opportunity to save health care in America. I think it’s just the opposite. I think mergers and acquisitions create an environment where it’s less service, higher costs, lower quality, and the community suffers. And I’m not sure how you feel about it, but that’s how I feel.

David Usher: I feel exactly the same way. I want to work in rural hospitals. It doesn’t mean you can’t affiliate have a partnership that’s equitable for both parties to get things done better for the patients. But it does mean you don’t have to be controlled by somebody else when we can’t allow big systems to come in here and create a whole good business.

JJ: Correct.

David Usher: Because we act as Victorian times, totally.

JJ: Have to shut our doors and then where are the services impacted the most? Right. Directly to the patient who cannot get the care in our community. Transportation or the lack thereof is a major issue. And the closest hospital, the biggest university hospital, Is in Ann Arbor for a university hospital, it’s an hour and a half away and for another large health system, 45 minutes to an hour away. So, access is very limited. And so, I perceive that we have to be disruptors, David, and we have to be bold and we have to have a growth strategy. It sounds like everything that you’re doing at your critical access hospital is to that end. You’re doing a remarkable job at first of all containing for a locally pandemic. But we moved through that and now it’s focused on a business model for sustainability. And having done a little research here, you all are doing it. And I would encourage you not to lose the faith to continue and to encourage others in our role that we have to fight. And it is so easy for these golden parachutes like you and I could get in our role. If we sell our hospital, they give us a nice little package for five years and they look very attractive and we’re not motivated by that. And I can tell from your perspective you’re not either, or you would be at a different place than you are doing the ministry and the work that you do there. So, all that to say, continue to fight the good fight, continue to be an advocate in Missouri, which when you get on the forums like you did to National Rural Health Association and other places, you’re carrying a message for us rule America so others can hear your voice. So, I want to thank you for championing that. I want to thank you for being part of the podcast today. It was great to hear your perspective in a state far away from Michigan and very similar to our plate here and what we’re facing, even with completely.

Rachel: Different Reimbursement models, we’re not critical access. But it just goes to show how the challenges that rural hospitals face are only well, if it’s not based on Reimbursement model, then maybe that tells us none of them reimbursement models work right if it doesn’t necessarily make the difference and we’re still all facing these same issues of sustainability. But as JJ alluded to and as a little behind the curtain for our listeners. I connected with David because on the kind of internal membership forums for the National Rural Health Association. There was a discussion about some funding and some legislation and he posted this very impassioned if it were in person. I would have called it like the best stump speech for rural health like I’ve ever heard. That just really was very you had a sense of urgency about that post that you put up that really spoke to me and I was like, this is our people, you know, and what we do here as well. And so, to JJ’s point, I mean, you are out there fighting the good fight and trying to bring this message forward and what a great opportunity to connect and to help other rural hospitals see what you’re doing and say, okay, you know what? We could try that. We could do this; we could focus on it. We need to be disruptors. We haven’t thought of doing it in this way or that way, I think is so important. So, I really appreciate your conversation and engagement, because that truly is why we’re here today. And I have a feeling this is the beginning of a very nice, long relationship absolutely. Between us and our hospital. And you and your hospital.

JJ: Well, we have to work together, and we’ve learned that in this industry, most recently, there are big health systems that would love to see us close. We know that. And they would capture those covered lives, and I’m not going to say they would get the best care. So, with that, David, I want to again, thank you for joining us today on Rural Health Rising. It’s been a pleasure to learn from your perspective and your seat as a Chief Financial Officer for Critical Access Hospital. So, thanks for joining us today on Rural Health Rising.

David Usher: Thank you. Bye bye.

JJ: And before we close, we like to do a fun segment with each of our guests. We want to know what is your most unique rural experience or just one of your favorite memories that is unique to rural life.

David Usher: Is unique to rural life. Certainly, an eye opener in Kansas. You’ve been in Canada a little while and looking to take some stuff to the landfill. Stop one of the guys 3 miles down the road. I still haven’t seen the steak hill almost 2 miles past Ten Foot Hill.

JJ: That’s just a little bit of a rise in the road. Well, I’ve enjoyed our time together, David, and I wish you nothing but success in your role for your community, your employees, but most of all for your patience. So, thanks for joining us.

David Usher: Thank you.

JJ: Next time on Rural Health Rising, we have another great conversation with another great guest, so be sure to tune in.

Rachel: And with that, don’t forget to subscribe wherever you get your podcast. And if you like what you hear, leave us a five-star review on Apple podcasts and tell others why they should listen too. Your feedback helps more listeners find rural health rising.

JJ: And you can now find us on Twitter. I’m at Hillsdale. CEO JJ Rachel is at rural health Rach. And you can also follow the podcast at rural health pod. Until next time, stay safe, stay healthy, and stay strong.

Rachel: Rural Health Rising is a production of Hillsdale Hospital in Hillsville, Michigan and a proud member of the Health Podcast network hosted by JJ Hodshire and Rachel Lott. Audio engineering and original music by Kenji Omer. For more episodes, interviews and more information, visit ruralhealthrising.com.

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